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PubMed2004

National Institutes of Health State-of-the-Science Conference Statement: Symptom management in cancer: pain, depression, and fatigue, July 15-17, 2002.

BACKGROUND: Despite advances in early detection and effective treatment, cancer remains one of the most feared diseases. Among the most common side effects of cancer and treatments for cancer are pain, depression, and fatigue. Although research is producing increasingly hopeful insights into the causes and cures for cancer, efforts to manage the side effects of the disease and its treatments have not kept pace. The challenge that faces us is how to increase awareness of the importance of recognizing and actively addressing cancer-related distress. The National Institutes of Health (NIH) convened a State-of-the-Science Conference on Symptom Management in Cancer: Pain, Depression, and Fatigue to examine the current state of knowledge regarding the management of pain, depression, and fatigue in individuals with cancer and to identify directions for future research. Specifically, the conference examined how to identify individuals who are at risk for cancer-related pain, depression, and/or fatigue; what treatments work best to address these symptoms when they occur; and what is the best way to deliver interventions across the continuum of care. STATE-OF-THE-SCIENCE PROCESS: A non-advocate, non-Federal, 14-member panel of experts representing the fields of oncology, radiology, psychology, nursing, public health, social work, and epidemiology prepared the statement. In addition, 24 experts in medical oncology, geriatrics, pharmacology, psychology, and neurology presented data to the panel and to the conference audience during the first 1.5 days of the conference. The panel then prepared its statement, addressing the five predetermined questions and drawing on submitted literature, the speakers' presentations, and discussions held at the conference. The statement was presented to the conference audience, followed by a press conference to allow the panel to respond to questions from the media. After its release at the conference, the draft statement was made available on the Internet. The panel's final statement is available at http://consensus.nih.gov. CONCLUSIONS: The panel concluded that the available evidence supports a variety of interventions for treating cancer patients' pain, depression, and fatigue. Clinicians should routinely use brief assessment tools to ask patients about pain, depression, and fatigue and to initiate evidence-based treatments. Assessment should include discussion about common symptoms experienced by cancer patients, and these discussions should continue over the duration of the illness. Impediments to effective symptom management in cancer patients can arise from different sources and interactions among providers, patients and their families, and the health care system. Numerous factors could interfere with adequate symptom management. Among these factors are incomplete effectiveness of some treatments, a lack of sufficient knowledge regarding effective treatment strategies, patient reluctance to report symptoms to caregivers, a belief that such symptoms are simply a part of the cancer experience that must be tolerated, and inadequate coverage and reimbursement for some treatments. Additional research is needed on the definition, occurrence, the treatment of pain, depression, and fatigue, alone and in combination, in adequately funded prospective studies. The panel also concluded that the state of the science in cancer symptom management should be reassessed periodically.

Depression↗
PubMed2004

The Junior Fellows Program: motivating urban youth toward careers in health, science, and medicine.

Lack of diversity in the health, science, and medical professions has been documented as a contributor to health disparities in the United States, and early intervention is essential for the recruitment of underrepresented students into the health professions. The Junior Fellows Program, a partnership between the New York Academy of Medicine, New York City public schools, and regional academic medical centers, is designed to stimulate students' interest in health, science, medicine, and research. From seminars designed to advance Junior Fellows' skills in identifying concrete strategies for improving health and preventing illness, to understanding the research process and the nature of scientific inquiry, the program engages Junior Fellows in project-based learning, works to enhance their critical thinking skills, and helps them to foster positive interactions with practicing physicians and health professionals. Surveys of program graduates indicate the program has been influential in creating a high level of motivation to pursue careers related to health, science, and medicine. The program continues to work on enhancing educational opportunities for urban public school students and promoting career awareness for the health professions, with a special emphasis on improving the proportion of minorities and women who enter these fields.

Academies and Institutes↗
PubMed2001

Rationalizing 'folk medicine' in interwar Germany: faith, business, and science at "Dr. Madaus & Co.'.

The relationship between orthodox or mainstream medicine and heterodox or alternative practices has often been expressed in terms of dichotomies, such as science versus anti-science or rationality versus irrationality. By studying the history of a company producing herbal medicines and homoepathic remedies in Germany in the 1920s and 1930s, this paper attempts to create a more differentiated picture. 'Dr. Madaus & Co.' was founded in 1919 by the three sons of a free church minister and his wife, who practised as a non-licensed healer herself. The company not only sold medicines, it also produced journals and books promoting heterodox healing methods and contributing to ongoing health political debates, for example over compulsory vaccination programmes, human experimentation, quackery, and a general 'crisis of medicine'. Gerhard Madaus, a medical doctor and one of the three founders, published in 1938 a three-volume Textbook of Biological Healing Methods, turning folk medicine into science. The essay follows the rise of the Madaus family firm and interprets the story of 'Dr. Madaus & Co.' as an example of social rationalization, emphasizing the role of commercial operations in twentieth-century alternative medicine in Germany.

Commerce↗
PubMedDate not supplied

Collaboration between cognitive science and cognitive rehabilitation: a call for action.

The fields of cognitive science and cognitive rehabilitation share a fundamental interest in the nature of cognition. Both groups address questions that are critical to our understanding of human thought. Researchers in basic cognitive science address these questions from a theoretical perspective. Clinicians in cognitive rehabilitation address them from an applied perspective for individuals with brain injuries. Collaborative efforts and cross-fertilization of theory and practice have been less than what might be expected given the underlying commonality of the two fields. Here, we explore the complex nature of the relationship between cognitive rehabilitation and cognitive science, discuss barriers to collaboration, and suggest ways of overcoming those barriers.

Brain Injuries↗
PubMed1983

Essential areas for behavioral science training: a needs assessment approach.

The design of effective behavioral science curricula for graduate medical education is an important link in the delivery of high quality medical care. Despite the work that has gone into developing methods of teaching and evaluating behavioral science training, as shown by numerous published articles, practicing primary care physicians still show deficits in handling patients' psychosocial problems. In this study, the authors propose the use of a behavioral science needs assessment questionnaire to ascertain the needs of residents for content areas based on the residents' medical school backgrounds and preferences for training. The questionnaire can also be used to monitor the effectiveness of existing curricula. The questionnaire was administered to 40 family practice residents in four programs to determine essential content areas. It was then used for curriculum planning in one program with 19 residents. Results from this program identified areas not covered in medical school and reflected the resident's comfort/confidence in practice in areas emphasized in the residency curriculum.

Attitude of Health Personnel↗
PubMed1986

Integrating basic science and clinical teaching for third-year medical students.

A two-month program for third-year students at the Albert Einstein College of Medicine of Yeshiva University provides a model for integrating basic sciences and clinical training. Entitled The Scientific Basis of Clinical Medicine, the course involves more than 100 basic science instructors and clinical instructors and is designed to foster recognition that good patient care requires physicians to evaluate the latest evidence of medical researchers. It also demonstrates the importance of lifelong learning in a field that constantly changes. Since 1978, the course has been offered in the spring of the third year after students as demonstrating "the continuum from basic science to clinical medicine" and as moderately successful in achieving its other objectives. Students view both its content and its less pressured environment after an intense year of clinical training as its major strengths.

Curriculum↗
PubMed1991

Shaping national science policy: some lessons learned.

Thirty-five years of experience have taught several lessons about shaping science policy. Derived from these lessons are four premises that deserve individual and collective thought: (1) The partnership in U.S. society between health and science interests is fundamentally important; (2) Scientific merit must be the paramount basis for allocating whatever research funds are available; (3) Better data and their careful analysis are vital to the decision-making processes; and (4) More than ever we must have a clear, concise, vigorous, and repeated enunciation of the principles that are essential for a national biomedical research program to flourish. The fourth premise is expressed succinctly in the 11 principles outlined in the 1983 AAMC monograph "Preserving America's Preeminence in Medical Research," which places important responsibilities for the collective success of the U.S. research program on all of the various components of society. Three important factors favor efforts to shape a useful, successful science policy: a public that places improvements in health high on every priority list, a rapidly expanding body of invaluable knowledge, and a sizable investment of tax-derived funds, now totalling over $7.5 billion per year.

Humans↗
PubMed1992

The coming influence of a social sciences perspective on medical education.

Medical education will change from within in response to continued advances in biological sciences and technology, but changes that are occurring outside the natural sciences can have greater impact, especially (1) the reconceptualization of the meaning of health, (2) the increase in the number and range of different health improvement strategies, (3) the growing awareness of the paradox of the relatively low health status of the U.S. population and high per-capita and national health care expenditures, and (4) shifts in the causes of illness and death. These changes make it necessary for medical students to be given a foundation in both the natural and the social sciences, for most ill health has causal roots in both the social and physical environment, even though it is not understood how some of these outside influences are translated into disease or biologic derangements that lead to disease. Consideration should be given to changes in medical education that include (1) interpreting the sociology as well as the biology of health, (2) expanding the horizons of medicine to incorporate health improvement as well as disease cure, (3) training for population-based health care at the community level, and (4) learning to assess medical outcomes with more than biometric measures to include measurements of functioning and well-being. The author presents in detail a health input-output model to show the complex interrelationships of socio-ecologic (i.e., outside) factors and the individual's genetic-biologic makeup (inside factors) that determine the individual's state of health.

Cause of Death↗
PubMed1994

Graduate education in the biomedical sciences: critical observations on training for research careers.

Several aspects of the processes for the pre- and postdoctoral training of PhDs and the postdoctoral research training of MDs are critically examined. The size of the predoctoral pipeline, the sources of support for the students in it, trends in the annual production of bioscience PhDs, and prospects for growth in opportunities, as defined in increases in availability of public and private funds for research, are catalogued. Evidence for the existence of a surplus of research scientists--based on the size and growth of the pool of postdoctorals, the success rates now being experienced by young postdoctorals in competing for National Institutes of Health (NIH) grants, and the success of young postdoctorals in securing career employment--is evaluated, and the conclusion that the nation is producing too many research scientists is suggested. The pros and cons of "downregulating" the production of scientists are explored, the difficulties of reaching a national consensus on the degree of reduction and the partition of reduction among fields of science and academic institutions and academic departments are described, and the mechanisms conceivably available for accomplishing the task--reducing NIH training funds, autoregulation by academic institutions and/or scientific disciplines, and reliance on the decisions of well-informed (probably by the National Academy of Sciences) degree candidates--are enumerated; a preference for the last of these mechanisms is indicated. The NIH's formal training programs are compared with its informal support of training under research grants; questions that the latter practice raises are identified. The striking disparity between the duration of training for conventional predoctoral PhD candidates and that for dual-degree (MD-PhD) aspirants is noted. The measurement problems of assessing the duration of postdoctoral training are highlighted. The fact that dual-degree scientists seem to compete little, if any, more successfully for the great bulk of NIH research grants than do singly-degreed MDs or PhDs is noted, suggesting the advisability of a fresh and objective review of these dual-degree programs, especially the NIH's Medical Scientist Training Program, to reassess their value in the light of their cost. Some characteristics of careers in the biomedical sciences are outlined. Data are presented on the high turnover rates of first-time-ever entrants into the pool of NIH grantees or, stated otherwise, the relatively low rates of survival of principal investigators (PIs) in the NIH research grant system; a method of estimating the steady-state number of NIH ex- PIs "around" at any given moment is proposed.(ABSTRACT TRUNCATED AT 400 WORDS)

Biological Science Disciplines↗
PubMed1996

Ethics issues in academic-industry relationships in the life sciences: the continuing debate.

The author reviews in detail the status of academic-industry relationships (AIRs) in the life sciences from both ethical and empirical perspectives, and identifies ethical issues that have been resolved and those that must still be debated. He summarizes by stating that ethical reasoning militates against the involvement of scientists and universities in those AIRs in which a financial conflict of interest on the part of life science investigators may affect the welfare of human subjects and trainees. Even in other types of AIRs, conflicts of interest have effects on professional decision making that could damage the integrity and productivity of life sciences research, especially scientists' withholding of data and their redirecting of research in more commercial directions. These effects could also help undermine public trust in and support of university researchers. Balanced against these worrisome effects are the benefits of AIRs in increasing some investigators' creativity and productivity, in encouraging technology transfer, and thus in promoting economic growth and public health. He concludes that more research is needed on the harms and benefits of AIRs, especially the development of better data on the effects of withholding data, and also on the economic and health benefits of AIRs and public attitudes toward issues of scientific research that involve possible conflicts of interest. More information on these questions would allow policymakers to make more realistic estimates of the gains and losses associated with AIRs. In the meantime, current information suggests that in general the conflicts of interest created by AIRs are real, consequential, but tolerable if managed carefully. Until more is known about the effects of AIRs, it is prudent for universities and faculty to participate at modest levels in such relationships and to monitor them carefully. This article is one of three in this issue of Academic Medicine that deal with issues of conflict of interest in university-industry research relationships. These articles are discussed in an overview that precedes them.

Biological Science Disciplines↗
PubMed1999

The plight of premedical education: myths and misperceptions--Part II: science "versus" the liberal arts.

For decades it has been known that students who major in non-science fields perform as well as science majors who go to medical school. Yet the overwhelming majority of future medical students still major in biology or chemistry, and organic chemistry has come to be the defining premedical science course. This article traces the history of the liberal arts tradition, discusses its importance for medicine, and urges that readers think about the medical college in the age of the university. The author believes that the medical faculties should take a lead in helping to reshape the premedical as well as the medical education of future doctors.

Curriculum↗
PubMed2004

Tenure in transition: trends in basic science faculty appointment policies at U.S. medical schools.

This article-based on a 2002 survey of 125 U.S. allopathic medical schools, reviews of institutional policy documents, and interviews with medical school leaders-explores and analyzes three trends in appointment and tenure policies for basic science faculty at U.S. medical schools. First, the percentage of full-time, nontenure track basic science faculty has increased, from 12% in 1980 to 20% in 2000. More dramatically, by the late 1990s, the percentage of new basic science faculty hired on a nontenure track surpassed the percentage hired on a traditional tenure-track line. This development stems from the tendency of some schools to appoint faculty to nontenure-eligible "research scientists" faculty tracks, to hire junior faculty on 100% grant funding, and to allow nontenure-track faculty to switch to the tenure track as their research career progresses. The second trend is an alteration to the tenure financial guarantee. Historically, at most medical schools, it was assumed that tenure guaranteed total institutional salary for basic scientists. Schools have begun to redefine that commitment to less than full salary to protect against financial vulnerabilities and to provide a means to reduce faculty salaries, if warranted. The third trend is increased flexibility to pretenure policies. Schools have lengthened probationary periods, revised up-or-out provisions, instituted stopping-the-tenure-clock policies and less-than-full-time appointments, and permitted faculty to switch between the tenure and nontenure tracks. These policy modifications recognize the increased professional and personal demands on faculty time.

Biological Science Disciplines↗
PubMed2006

Data withholding in genetics and the other life sciences: prevalences and predictors.

PURPOSE: To better understand the variety and prevalence of data withholding in genetics and the other life sciences and to explore factors associated with these behaviors. METHOD: In 2000, a sample of 2,893 geneticists and other life scientists (OLS) at the 100 most research-intensive universities in the United States were surveyed concerning data withholding and sharing. The instrument was developed and pretested in 1999. The two primary outcome measures were withholding in verbal exchanges with colleagues about unpublished research (verbal withholding) and withholding as part of the publishing process (publishing withholding). The independent variables related to the personal characteristics, research characteristics of faculty, and previous experience with data withholding. RESULTS: A total of 1,849 faculty responded (64%): 1,240 geneticists and 600 OLS. Forty-four percent of geneticists and 32% of OLS reported participating in any one of 13 forms of data withholding in the three previous years. Publishing withholding (geneticists 35%, OLS 25%) was more frequent than verbal withholding (geneticists 23%, OLS 12%). In multivariate analyses, male gender, participation in relationships with industry, mentors' discouraging data sharing, receipt of formal instruction in data sharing, and negative past experience with sharing were significantly associated with either verbal or publishing withholding among either geneticists or OLS. CONCLUSIONS: Data withholding is common in biomedical science, takes multiple forms, is influenced by a variety of characteristics of investigators and their training, and varies by field of science. Encouraging openness during the formative experiences of young investigators may be critical to increased data sharing, but the effects of formal training do not appear straightforward.

Access to Information↗
PubMed2006

Behavioral science education and the international medical graduate.

PURPOSE: International medical graduates (IMGs), many of whom are recent immigrants to the United States, are filling an increasing proportion of U.S. family medicine residency positions. Therefore, assumptions about the training experiences of first-year residents may no longer apply to a large percentage of incoming residents. The authors sought to improve the behavioral science education in their residency program by learning about IMGs' previous training and experience in behavioral science before coming to the United States. METHOD: Ten first-, second-, and third-year family medicine residents, representing medical school training from India, Macedonia, Bosnia-Herzegovina, The Philippines, Egypt, and Iraq, were individually interviewed using an inductive, qualitative approach. Transcripts were reviewed and double coded. Categories and story lines were identified, and member checking was employed. RESULTS: Segments were classified into seven categories: residents' behavioral medicine training prior to coming to the United States; reflections on the inclusion of mental health and psychosocial content in clinical family medicine; training in medical interviewing; reflections on the physician-patient relationship; perceptions of U.S. family life; recommendations for improving IMGs' understanding of psychosocial aspects of patient care; and specific challenges residents face as IMGs. CONCLUSIONS: The narrative data suggested several possible modifications to the family medicine curriculum, including expanding new resident orientation content about U.S. health care, introducing behavioral science content sooner, and having IMGs observe quality physician-patient interactions. Interview data also yielded concrete suggestions for improving residents' psychiatric interview knowledge and skills, such as instruction in specific wording of questions.

Adult↗
PubMed1991

Nursing: a practical science of caring.

Knowledge development related to caring is examined from the epistemological perspective of nursing as a practical science. Four stages of knowledge development for a practical science of caring are proposed and then used as a basis for evaluating efforts to develop a body of knowledge related to caring. Issues that need to be addressed to facilitate the advancement of nursing as a practical science of caring are identified.

Humans↗
PubMedDate not supplied

A methodology for critical science in nursing.

There is confusion surrounding critical science in nursing. Many studies which could be considered critical do not identify themselves as such. Reasons for this may be the lack of a clear definition of critical science in nursing or the failure of the discipline to identify the defining characteristics of a critical methodology. This article addresses the confusion by defining critical science in nursing in addition to presenting a critical methodology synthesizing 7 common processes seen in critical research.

Humans↗
PubMed2003

Emerging out of nature into history: the plurality of the sciences.

The idea of a 'theory of everything' is inconsistent with a natural feature of biological evolution: the spontaneous emergence of composite entities with completely new properties. At successively higher levels of complexity, from elementary particles and chemical molecules, through unicellular and multicellular organisms, to self-aware human beings and their cultural institutions, we find systems obeying entirely novel principles. The behaviour of such systems is not predictable from the properties of their constituents, so distinct 'languages' are required to describe them scientifically. The plurality of our sciences is thus an irreducible feature of the universe we live in. In particular, the reversible time coordinate of mathematical physics cannot cope with the natural 'path dependence' of biology. In the human sciences this extends into the imagined future as well as the remembered past. Furthermore, science nowadays usually arises in localized social contexts, where the 'logic of the situation' is continually being transformed by the emergence of cultural novelties such as unpredictable technological innovations. Thus, scientific knowledge cannot be restricted to generalized synchronic models, but involves historical narratives of specific events and unforeseen circumstances.

Adaptation, Physiological↗
PubMed2005

From fuzzy logic toward plurimonism: the science of active and empathic observation.

Plurimonism is a new philosophy and method of science. It holds that the revolution in computer science and artificial intelligence has reached the point that all the sciences in general can now account for the complex relations of an irreducible plurality of unique observers engaged in describing the same event. Plurimonism seeks to describe the conscious and unconscious relations of the scientific observer during the act of observation of a given event while preserving the historical uniqueness and indivisible identity of each such observer. Using the framework of plurimonism, we mathematically formulate the problem of empathy. This self-reflective mathematical model entails four components of the empathic process involving two observers. They are: 1) the self; 2) the self's-other; 3) the other; and 4) the other's-self. It measures the degree of accuracy of the therapist-observer's empathy, as well as conscious and unconscious processes involved in the patient-observer's idealization and the therapist-observer's confidence in clinical psychotherapy. Ratings are obtained from both patient and therapist from four different points of view. The plural views of the patient's global assessment of functioning (GAF) are from: 1) the therapist's view (TGAF); 2) the patient's view (PGAF); 3) the therapist empathic view (TEGAF), which represents the therapist's estimate of PGAF; and 4) the patient's empathic estimate of the TGAF. The GAF scale is the standard dimensional 100-point-scale measure used in psychiatry for recording a patient's functioning. The patient's estimate of the therapist's degree of accuracy as well as the therapist's confidence in his or her empathic accuracy is also represented. Three formulae are presented that describe the degree of the therapist's empathic accuracy, the patient's over-idealization/under-idealization, and the therapist's over-confidence/under-confidence. The concept of empathy is here restricted to mean the degree to which one observer can take the point of view of another observer when both are observing the same thing.

Cybernetics↗